Extracranial, Renal, thoracic outlet and Mesenteric

Question 1

what is a stroke ?

Answer 1

defined as a neurological deficit that lasts more than 24 hours

Question 2

what is a transient ischemic attack ?

Answer 2

a neurological deficit that lasts less than 24 hours

Question 3

what is the main cause of carotid territory ischaemic stroke ?

Answer 3

thromboembolism

Question 4

what are the carotid territory symptoms?

Answer 4

hemisensory/motor signs , dysphagia and amaurosis fugax

FAST

Question 5

what investigations would be taken forcarotid occlusiive disease?

Answer 5

lab investigations: CBC, Lipid Profile, coagulation profile, urea and creatinine and glucose
echo
duplex
CTA or MRA could be used pre-operativley

Question 6

what is the first line of investigationin carotid artery stenosis?

Answer 6

duplex

Question 7

what is the most appropriate management for carotid disease ?

Answer 7

BMT
CEA/CAS
timing is important

Question 8

what are the complications of carotid endarterectomy?

Answer 8

stroke
bleeding and hematoma formation
cranial nerve injury (12,10,9)
hypoglossal - tongue deviation
hoarsness of voice - vagus nerve affection
difficulty swallowing - glossopharyngeal

Question 9

what is the most common pathological condition of the renal arteries ?

Answer 9

atherosclerotic stenosis

Question 10

what are the management options for atherosclerotic renal vascular disease ?

Answer 10

medical therapy and may be considered for re vascularisation by either endovascular or surgical means

Question 11

what are the options for renal replacement therapy ?

Answer 11

haemo-filtration
peritoneal dialysis
heamodialysis
transplantation

Question 12

what type of access is made for renal replacement therapy patients ?

Answer 12

arteriovenous fistula

arteriovenous graft

Question 13

how long does a native fistula take to mature

and how long does a graft take to mature ?

Answer 13

6 months

a graft takes 6-8 weeks

Question 14

when should a native fistula be created ?

Answer 14

6 months before need

Question 15

what is the rule of 6 in the ideal AVF conduct ?

Answer 15

flow rate of at least 600ml/min
should lie less than 6mm below the surface of the skin
minimum diameter of 6 mmi

Question 16

ideally how many dialysis needles can be placed with AVF ?

Answer 16

2 dialysis needles

Question 17

what are the common sites for an AVF ?

Answer 17

wrist radiocephalic
wrist ulnobasilic
brachiobasilic
brachiocephalic

Question 18

what are the access complications ?

Answer 18

stenosis 
thrombosis
infection 
failure to mature 
steal syndrome 
high flow cardiac failure 
aneurysm formation

Question 19

where is the thoracic outlet?

Answer 19

region at the top of the rib cage between the base of the neck and the axilla

Question 20

what are the contents of the thoracic outlet ?

Answer 20

brachial plexus

subclavian vessels

Question 21

which gender is TOS more common in ?

Answer 21

women

Question 22

what are the causes of thoracic outlet syndrome ?

Answer 22

anatomical factors such as a cervical rib
fibrous bands
repetitive injuries

Question 23

what is the most common congenital abnormality causing TOS?

Answer 23

fibrous bands which transverse the thoracic outlet

Question 24

what are the three forms of TOS ?

Answer 24

neurogenic TOS
Arterial TOS
Venous TOS

Question 25

what is the most common form of TOS ?

Answer 25

neurogenic

Question 26

what are the symptoms of neurogenic TOS?

Answer 26

symptoms in the ulnar nerve distribution pain when raising the arm paraesthesia on the medial side of the arm

Question 27

where does the pain radiate with neurogenic TOS ?

Answer 27

radiates to the axilla shoulder and back

Question 28

what tests provoke positive findings in neurogenic TOS ?

Answer 28

Adson test | Roos test

Question 29

what is the presentation of venous TOS ?

Answer 29

patient may present with cyanosis and arm swelling

Question 30

what is paget-schrotter syndrome ?

Answer 30

is a form of upper extremity DVT presennt with venous TOS

Question 31

what is the rarest form of TOS?

Answer 31

arterial TOS

Question 32

what is the presentation of arterial TOS ?

Answer 32

attacks of pallor, pain paraethesia

Question 33

what is the treatment of NTOS

Answer 33

conservative treatment avoid repetitive ovberhead work correct posture strengthen shoulder elevating muscles

Question 34

when is surgery indicated with NTOS ?

Answer 34

if the conservative treatment failed to improve symptoms | or if the symptoms interfere with work or daily activities

Question 35

what are the treatment protocols for VTOS ?

Answer 35

thrombolysis and correction of anatomical abnormalities | first rib resection

Question 36

what are the treatment protocols for ATOS ?

Answer 36

thromboelectomy followed by excision of the cervical first rib

Question 37

how is the colon protected from ischaemia ?

Answer 37

marginal artery of drummond

Question 38

what are the types of mesenteric ischaemia ?

Answer 38

acute mesenteric ischaemia | chronic mesenteric ischaemia

Question 39

where is the problem when it comes to acute mesenteric arterial embolism ?

Answer 39

superior mesenteric artery

Question 40

where is the problem when it comes to acute mesenteric arterial thrombosis ?

Answer 40

at the vessel's origin resulting in extensive bowel involvement

Question 41

what are the causes of nonocclusive mesenteric ischaemia ?

Answer 41

cocaine vasopressors hypotension

Question 42

what are the causes of mesenteric venous thrombosis ?

Answer 42

``` hypercoaguability from protein s and c deficiency tumor infection pancreatitis venous trauma ```

Question 43

what are the signs and symptoms of acute form of mesenteric ischaemia ?

Answer 43

Abrupt severe abdominal pain urgent need to have bowel movement fever nausea and vomiting

Question 44

what are the complications of acute mesenteric ischaemia ?

Answer 44

sepsis irreversible bowel damage death

Question 45

what lab results can show acute mesenteric ischaemia ?

Answer 45

raised WCC and lactate

Question 46

what imaging modality can be used to show acute mesenteric ischaemia ?

Answer 46

CTA or CT with IV contrast

Question 47

what are the signs and symptoms of chronic mesenteric ischaemia ?

Answer 47

abdominal pain that starts 30 minutes after eating pain that worsens over an hour pain that goes away within three hours

Question 48

what is the investigation of choice ?

Answer 48

CTA

Question 49

what can people with chronic mesenteric ischaemia suffer from ?

Answer 49

unintentional weight loss fear of eating acute on top od chronic mesenteric ischaemia

Question 50

what is the treamtment for mesenteric ischameia ?

Answer 50

revascularization | resection of non viable bowel

Question 51

what are the indications for CEA ?

Answer 51

more than 50% stenosis in symptomatic patients more than 70% stenosis in asymptotic patients fluctuating neurological symptoms , evolving TIA

Question 52

what is the best management if you have bilateral carotid stenosis ?

Answer 52

fix the more stenotic one first if the same degree off stenosis , fix the dominant hand first

Question 53

when should we perform carotid stenting ?

Answer 53

previous CEA and high risk patients

Question 54

what is the first branch of thee ICA ?

Answer 54

ophthalmic artery

Question 55

what is the first branch of the ECA ?

Answer 55

superior thyroid artery